MAUDE Adverse Event Report: ZIMMER DENTAL 15 DEG TAPER 4.5P 2MM-3MM; DENTAL ABUTMENT

Catalog Number	15AT423
Medical Device Problem Code	Unintended Movement (3026)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/09/2024
Type of Reportable Event	Malfunction
Event or Problem Description
The abutments loosening several times 3 months after placement.This event is intended to capture the third loosening event.
Additional Manufacturer Narrative
Zimvie complaint number (b)(4).D10.Concomitant medical products tacw2, abut tapered one-piece sc r-v 4.5mm 2mm lot 2021070143.
Additional Manufacturer Narrative
Zimvie complaint number (b)(4).Zimvie received one (1) 15at423, (15 deg taper 4.5p 2mm-3mm) for evaluation.Visual evaluation and a functional test was performed, signs of use was identified.The abutment had signs of use.The screw threaded into in-house implant as intended.Unable to confirm loosening with all the available information.Device history record (dhr) review was completed for the subject lot number 2020111244.No deviations or non-conformances, which could have caused or contributed to the reported event, were noted as part of the dhr.Complaint history review was performed for the reported lot number 2020111244 for similar events and 2 other relevant complaint(s) were identified.Review completed utilizing keywords: dental: functional: loosening.The customer did submit images for the reported event.The image was of a driver, screw and an abutment with a fractured hex.There was an xray of an implant with an abutment attached.Based on the investigation and risk management file review, the most likely root cause determined from the investigation was the screw wasn¿t torqued to specification.Therefore, based on the available information, a device malfunction did not occur.The screw threaded into an in-house implant as intended.The reported event was non-verifiable with all the available information.No further investigation or immediate capa / hhe/d escalation is required, as the complaint investigation did not confirm the products were nonconforming at the time of distribution, and no new failure mode, harm, or hazardous situation was identified through the investigation performed.At this time, the complaint investigation has been completed and the record will be closed.If additional information is received, the record will be re-opened for further evaluation.
Event or Problem Description
No further event information is available at the time of this report.

• Brand Name: 15 DEG TAPER 4.5P 2MM-3MM
• Common Device Name: DENTAL ABUTMENT
• Manufacturer (Section D): ZIMMER DENTAL; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer (Section G): ZIMMER DENTAL; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer Contact: carlos gordian-arroyo ; 4555 riverside drive; palm beach gardens, FL 33410 ; 5619713230
• MDR Report Key: 20804034
• Report Number: 0002023141-2024-03874
• Device Sequence Number: 9940788
• Product Code: NHA
• UDI-Device Identifier: 00889024012073
• UDI-Public: (01)00889024012073(17)251126(10)2020111244
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K111853
• Exemption Number: 5645646
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 03/13/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Expiration Date: 11/25/2025
• Device Catalogue Number: 15AT423
• Device Lot Number: 2020111244
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/07/2024
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 11/28/2024
• Supplement Report FDA Received Date: 03/14/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/25/2020
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: DENTAL ABUTMENT SEE H10 NARRATIVE
• Patient Sex: Female
• Patient Ethnicity: Non Hispanic